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Survey Gives Voice to RI Youth; Reveals a Mix of Health Behavior Trends

Results from a comprehensive youth health survey released today suggest that middle and high school students in Rhode Island have made improvements in health behaviors over the past 10 years in many areas, including seat belt use, sexual activity, and alcohol and illegal prescription drug use. However, through the survey, the voices of Rhode Island youth revealed some concerning trends, including trends related to mental health, e-cigarette use, and marijuana use.

The Youth Risk Behavior Survey is a collaboration between the Centers for Disease Control and Prevention (CDC), the Rhode Island Department of Health (RIDOH), the Rhode Island Department of Education (RIDE), and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH). The survey, which is administered every two years, is implemented through anonymous questionnaires in Rhode Island public schools. These most recent data were collected from January 2017 to May 2017. The data are used to help policy makers, school administrators, social service workers, and public health professionals understand trends in the health behaviors of young people across the state and to create health-related policies that will impact those behaviors. By participating, schools make sure their students' voices are heard and can get resources with the support needed to help solve pressing challenges, like student stress, substance abuse, and bullying.

"Supporting the healthy development of middle school and high school students requires us to have an accurate, comprehensive understanding of the issues they face. The Youth Risk Behavior Survey is an invaluable tool in our work to develop such an understanding, by making sure we can hear directly from students themselves, and to do all we can to help Rhode Island kids be healthy and safe," said Director of Health Nicole Alexander-Scott, MD, MPH. "The Youth Risk Behavior Survey also helps us learn from the voices of our young people to understand how students are disproportionately affected by different health issues. Understanding these disparities allows us to better address the factors at the community-level that affect students' decisions and behaviors. All students in Rhode Island deserve an equal opportunity to be heard, so they can access what they need to be healthy and thrive."

"Like SurveyWorks, Rhode Island's school culture and climate survey, the Youth Risk Behavior Survey puts student voice at the center of policymaking and allows young people to share their experiences in a safe, anonymous way," said Ken Wagner, Commissioner of Elementary and Secondary Education. "When we amplify student voice, we are better positioned to foster safe, supportive, and inclusive learning environments that empower all students and put them on a path to success."

"Rhode Island leads the nation in adolescent immunizations and we have the third highest insured rate for youth. Yet, data trends related to mental health, substance use, and physical activity from this YRBS survey, especially highlighting certain important populations, show that we have more work to do to support our youth as they face complex challenges every day," said EOHHS Secretary Eric J. Beane. "I am pleased to see these federal and state agencies come together and administer this survey, which allows our youth to tell us about their own experiences, and guide us in how we can best serve them."

"BHDDH is committed to utilizing data-driven decision making as the basis for our programming directed towards youth and young adults. For the most comprehensive understanding of what supports our schools and families need to address the challenges that Rhode Island middle and high-school students face, we depend on our three state school surveys to amplify their voice: BHDDH's Rhode Island Student Survey, RIDE's SurveyWorks, and YRBS data through RIDOH, which allows for comparisons to other states," said BHDDH Director Rebecca Boss. "Since we work in conjunction with RIDOH and RIDE, new results, such as what we've learned from the YRBS survey given to our youth population, are critical in developing services that will have the optimal impact."

Rhode Island YRBS data overview

Examples of health behavior improvements - Tobacco, illegal prescription drug, and alcohol use: 5% of middle school students have ever tried cigarette smoking, down from 16% in 2007. In 2017, 6.1% of high school students currently smoke, a decline from 15% in 2007. 7% of high school students reported having ever misused a prescription drug, a decrease from 14% in 2011. The percentage of high school students who currently drink alcohol was almost cut in half in 10 years (43% in 2007 to 23% in 2017). - Driving: High school students who reported that they rode with a driver who had been drinking decreased from 28% in 2007 to 14% in 2017. In 2007, 14% of students reported rarely or never wearing a seat belt when riding in the car driven by someone else. This decreased to 7% in 2017. - Sex: The percentage of middle school students who have ever had sex decreased from 15% in 2009 to 8% in 2017. The percentage of high school students who have ever had sex decreased from 46% in 2007 to 36% in 2017. Some concerning trends - Mental health: 23% of middle school and 29% of high school students were so sad or hopeless almost every day for two weeks or more that they stopped usual activities. 12% of Rhode Island high school students considered suicide in the past year in 2007, compared to 16% in 2017. In 2017, 14% of high schoolers said they had made a suicide plan in the past year. The percent of high school students who reported attempting suicide in their lifetime increased from 9% in 2007 to 11% in 2017. - Smoking electronic cigarettes: 16% of middle school students have ever tried e-cigarettes and 6% currently use e-cigarettes. 40% of high school students have tried an electronic vapor product, and 20% have done so in the past 30 days. - Marijuana use: Rates of marijuana use have not decreased in the last 10 years. In 2017, 23% of Rhode Island high school student smoked marijuana in the past 30 days, the same percentage from 2007. 9% of middle school and 37% of high school students report having ever used marijuana. Examples of health disparities - Mental health: The prevalence of sadness and suicide risk behaviors are two to four times higher among students who identify as lesbian, gay, or bisexual, compared to their heterosexual peers. Mental health issues were more common among female and Hispanic high school and middle school students. In addition, students with disabilities had a significantly higher rate of sadness and four times the prevalence of suicide ideation and suicide attempts compared to students without disabilities. - Bullying: 17% of students were bullied on school property, and 14% were cyber-bullied in the past year. Students who identify as lesbian, gay, or bisexual (31% for both types of bullying) and students with a disability (30% at school, 25% cyber) experienced bullying at higher rates than their peers. Hispanic and Caucasian high school students were more likely to be bullied at school and online, compared to African American students. Female high school students experienced higher rates of cyber-bullying than males. - Smoking: 34% of students who identify as lesbian, gay, or bisexual have ever smoked cigarettes, compared to 18% of students who identify as heterosexual. 52% of students who identify as lesbian, gay, or bisexual have ever used e-cigarettes, compared to 39% of students who identify as heterosexual. The rate of current cigarette smoking and e-cigarette use is higher among Caucasian high school students, compared to African American students. Current e-cigarette use is higher among male high school students than females. - Marijuana use: Hispanic middle school students had a higher prevalence of use than Caucasian students. Males were more likely than female middle school students to try marijuana before age 11. - Physical activity: 32% of students with disabilities were physically active for at least 60 minutes five days a week, compared to 44% of students without a disability.

Additional Youth Risk Behavior Survey data on other health trends are available online. Only statewide data are available. (Data are not available by city and town.) However, comparisons between Rhode Island and other states are available online.

At RIDOH, data from the Youth Risk Behavior Survey are used to develop health programs for teenagers throughout Rhode Island. For example, RIDOH's Youth Suicide Prevention Program uses the data to examine the co-occurrence of suicidal thoughts with answers to other survey questions to help those in the suicide prevention field address suicide risk and protective factors specific to youth. Additionally, RIDOH's Sexually Transmitted Disease and HIV Prevention Programs implemented a comprehensive, youth-focused social media campaign partially in response to Youth Risk Behavior Survey data. In addition to this work, the Rhode Island Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH) uses Youth Risk Behavior Survey data to better understand and address substance use among youth in Rhode Island.

The Youth Risk Behavior Survey data are collected in a safe, confidential way. It has been conducted nationally since 1991, with validated methodologies and effectiveness. CDC confirms that there is no evidence that asking students about health behaviors will encourage them to experiment with those behaviors. Results are secure and anonymous. Because no identifiable information is collected about students (such as names or dates of birth), there is no way to link responses to individual students, and students who participated cannot be tracked. Additionally, all parents are informed before the survey is administered that the survey is optional.

The process for the 2019 YRBS spring data collection will begin at the end of this year. Through coordination of YRBS of behalf of RIDOH, along with RIDE's SurveyWorks and BHDDH's Rhode Island Student Survey, the state will continue to work to ensure that students' voices are heard and that they have the resources they need for success in school and beyond.

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